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As the newest class of student doctors begins their journey to become osteopathic physicians, we would like to highlight recently reported survey results published by the American Association of Colleges of Osteopathic Medicine (AACOM)1 about certain characteristics of the class of 2014. These findings, which have important implications for the recruitment and training of future osteopathic medical students, may be of interest to faculty and administrators at colleges of osteopathic medicine (COMs).

The AACOM study1 presents results from an intriguing survey of more than 12,000 students who applied to COMs in 2009 for admission to the class of 2014. Respondents (2701 of 12,617 [21.4%]) answered a diverse series of questions concerning their medical school application choices (ie, osteopathic only or osteopathic and allopathic), acceptance outcomes, enrollment decisions, and educational achievements (ie, grade point average, Medical College Admission Test score). These data indicate that 69.8% (1885 of 2701) of respondents applied to both osteopathic and allopathic medical schools, and that 54.8% (1480 of 2701) of respondents were accepted to at least 1 COM, compared to 37.6% (709 of 1885) who were accepted to an allopathic medical school.

Interestingly, of the 1480 respondents who were accepted to at least 1 COM, only 66.2% (980 of 1480) actually enrolled in a COM the following academic year.1 Moreover, of the 500 respondents who were accepted to a COM but did not matriculate to a COM, 83% (415 of 500) matriculated for classes at an allopathic medical school. These data reveal that many aspiring physicians are applying to both osteopathic and allopathic medical schools, but when accepted to both types of medical schools, applicants overwhelmingly decide to enroll in allopathic medical schools.

Results from additional questions on the AACOM survey1 provide a greater understanding of why osteopathic medical school applicants choose to enroll in allopathic vs osteopathic medical schools when admitted to both types of institutions. For example, respondents were asked to select those factors that were most influential in their enrollment decisions. Respondents who enrolled in osteopathic medical schools and those who enrolled in allopathic medical schools had several reasons in common for their enrollment decisions. For example, the majority of students in both groups indicated that geographical location was among the top reasons for selecting a medical school.

However, students in the 2 groups differed in the reported importance of several factors that they considered in their enrollment decisions. For example, 49% of respondents who enrolled in allopathic medical schools indicated that cost was an important factor in their decision-making process, compared to only 14% of respondents who enrolled in COMs.1 In addition, 39% of respondents who enrolled in allopathic medical schools indicated that degree preference was an important factor in their decision, compared to only 18% of respondents who enrolled in COMs.

Based on the results of the AACOM survey,1 students who are admitted to both osteopathic and allopathic medical schools choose to enroll in allopathic medical school because of location, cost, and a preference for obtaining an MD degree rather than a DO degree. These findings were likely influenced by the fact that there are many more public allopathic medical schools with lower tuition costs compared to osteopathic medical schools, the majority of which are private. However, these findings also suggest that an inherent bias exists in the perceived value between MD and DO degrees, resulting in a preference for enrollment in allopathic medical schools over osteopathic medical schools.

Understanding why medical school applicants choose to enroll in allopathic vs osteopathic medical schools has important implications for the future of osteopathic medicine. The study by AACOM1 reveals that few applicants to COMs (29%) indicated that osteopathic philosophy was an important factor in choosing to enroll in a COM. How might this finding relate to student attitudes toward osteopathic manipulative medicine (OMM) and osteopathic manipulative treatment (OMT)? This relationship is worth exploring, because a lack of enthusiasm or understanding of osteopathic philosophy might be correlated with a lack of interest in pursuing a career in medicine that incorporates OMM and OMT.

Understanding why osteopathic philosophy plays such a small role in students' decisions to enroll in COMs is also relevant in the context of the growing number of COM graduates entering internships and residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME).2,3 Furthermore, understanding this matter is important in the context of the diminished use of OMT by osteopathic physicians.4

Despite the growth in the numbers of COM applicants and graduates, data in the AACOM study1 indicate that applicants to COMs (including many in the class of 2014) were motivated to enroll in COMs for reasons other than a desire to become an osteopathic physician or to become trained in OMM. What can be done to recruit students who have genuine interest in osteopathic medicine and professional aspirations for life-long careers practicing OMM? Results from the AACOM study1 indicate that more than 50% of survey respondents already had definite plans to pursue careers in medicine by the time they had graduated from high school. Given that it is likely that most high school students know little (if anything) about osteopathic medicine, these results suggest that the development of more diverse methods to disseminate information about osteopathic medicine, osteopathic medical education, and osteopathic philosophy to this young population of future physicians is in great need. Moreover, recruitment programs targeting students in the earliest years of college might help to combat the bias and prejudice against the DO degree that develops by the time students apply to osteopathic medical schools.

Results from the AACOM study1 quantitatively describe what many osteopathic students, as well as faculty and administrators at COMs, may have already suspected—many osteopathic medical students are primarily motivated by a general career goal in medicine, not osteopathic medicine in particular. These data might also provide clues to understanding the current trends of decreased interest among first-year osteopathic medical students in pursuing careers in primary care and of the decreased number of COM graduates in primary care residency programs.5 These trends indicate that applicants and matriculates are not especially interested in osteopathic medical schools because of a perceived focus in training primary care physicians. In fact, these students may view a COM's focus on primary care as a negative attribute that might limit their future professional opportunities.

Results from the AACOM study1 point to important challenges faced by COMs in providing an educational experience that trains the next generation of osteopathic physicians to be competent, culturally aware, and patient-centered, as well as to have a firm understanding and to embrace OMM and osteopathic philosophy.